The Gag Rule's Victims

During her third pregnancy, Maya, a Nepalese woman, suffered from frequent dizzy spells. At seven months pregnant, she took pain tablets for relief and, as a result, miscarried. Shortly afterwards, her landlord accused her of murder, and the police came. Maya was sentenced to twenty years in prison for inducing an abortion. Though the sentence was later reduced to two years, she is still in prison.

On a fact-finding mission to Nepal earlier this year, staff from the Center for Reproductive Law and Policy met and interviewed Maya (not her real name) and many others in similar situations. Due to poor prenatal health care, one out of every ten pregnancies in Nepal results in a miscarriage, the center says, and there are about 4,500 maternal deaths per year.

Women in Nepal who miscarry or choose to have an abortion face some of the stiffest legal and social penalties in the world. Having an abortion there is considered infanticide. It is illegal in every circumstance and is punishable by life in prison.

Rami is a Nepalese girl of fourteen who was raped by her uncle and gave birth to a baby who was born dead. Scared and confused, she buried the baby. Eight days later, fellow villagers discovered the body and reported her to the police. They believed she'd had an abortion, and the young teen was charged with infanticide. The sentence was life in prison.

Pima is an eighteen-year-old woman in Nepal who has four daughters. Last year, when she became pregnant for a fifth time, a local assistant health care worker told her husband she might have another girl. Her husband responded by tying her hands and legs with rope and forcing her to have a brutal abortion against her will. Pima cried out for help until she passed out. No one responded. Once she awoke, pain kept her from speaking for a week, after which time she was informed that the aborted fetus had been a boy. Pima's injuries are permanent, and her health is deteriorating.

I heard these last two stories from Sapana Malla, a prominent women's rights advocate with the Forum for Women, Law, and Development in Nepal. (The women's names have been changed.) Sixty-five women are in currently in prison in Nepal for having an abortion, Malla says. It is almost always the women--rather than men who force them to have abortions or the doctors who perform them--who are jailed, she says.

"Married, widowed, unmarried, children under sixteen, victims of rape and incest--all are in prison," Malla tells me. Sometimes, the children of an imprisoned mother are incarcerated with her, Malla adds.

But if Malla's organization were to take any U.S. funding--including money from USAID (the U.S. Agency for International Development), which is heavily relied upon in Nepal--she would be prohibited from voicing these stories. Nor could she advocate changing Nepalese law. That's because on January 22, on his first working day as President, George W. Bush reinstated what he calls his "Mexico City Policy" but what pro-choice and human rights advocates dub the "Global Gag Rule." First instituted by Ronald Reagan in 1984 during his attendance at a United Nations conference in Mexico City, the policy bans any group receiving U.S. funding from using even its own money to perform abortions or to speak freely about abortion law reform. To get U.S. funds, those organizations must take a vow of silence. "The gag rule is definitely going to affect our law and policy," says Malla.

Just 29 percent of women use any birth control, according to the Center for Research on Environment, Health, and Population Activities in Nepal. Many Nepalese women have illegal abortions, risking prison, serious injury, sterility, and even death.

Yet Nepal is on the verge of change. The Ministry of Health has gathered statistics showing that Nepal has one of the highest maternal mortality rates in the world--539 out of 100,000--half due to unsafe abortions. It has labeled this a crisis and is working to change the law. And members of parliament have indicated a willingness to move toward legalization. But to overturn the abortion ban, Nepal's officials will need the backing of nongovernmental groups, many of which have been gagged.

That's why the timing of the Bush policy could not be worse. "In order to push through all these changes, we are definitely going to need the support of all the health service providers, and it looks like we are not going to be able to get it because of the gag rule," says Melissa Upreti, a Nepalese attorney with the Center for Reproductive Law and Policy in New York. "These people deeply influence policy, but they cannot take a position in support of this health reform." The Bush policy, more than any local opposition, represents the biggest problem, she says.

In March, Upreti traveled to Nepal to visit women in eight prisons who had been charged with having abortions. She met women who were in prison even though they told her they had spontaneous miscarriages. Many women were sharing a single room that was poorly lit and lacked basic facilities.

"There were some prisons where there were six or seven women sharing two rooms with stone walls and bars for doors and plastic hanging over the windows and tied to the doors--summer or winter that was all there was to protect them," she says. "Women convicted of abortion were in the same place as women convicted of murder."

Many of the women Upreti met in prison were from poor, rural areas, where health care is scarce and biases are strong. "Rural women don't really have any access at all so they resort to inserting broken glass into the uterus or pummeling the stomach until the uterus tears," Upreti tells me. Often, women cross into bordering India for "lunch-hour abortions," which allows for no follow-up care or liability for providers.

Sometimes, women end up in prison because someone with a grudge has turned them in.

Anand Tamang, the director of the Center for Research on Environment. Health, and Population Activities, cites the story of a domestic servant who was a widow and mother of four children. She got pregnant with a man who promised to marry her and upon learning of the pregnancy allegedly gave her medication to expel the fetus. She confided in a friend who told the community. She was arrested and sentenced to life in prison. The only thing unusual about her case was that her partner was also arrested, but he allegedly bribed officials and was quickly released without charge, says Tamang, who relates this story on the web site of the Center for Reproductive Law and Policy. These women rarely understand the judicial system--and with good reason. Sentences are unevenly applied and often women aren't told of their rights until after the trial. "It's a bad law implemented in a bad manner," says Upreti.

The majority of the Nepalese public support changing it, according to Tamang. His center's statistics show that 20 percent of incarcerated women in Nepal have been charged with abortion and infanticide. Somewhere between a quarter to more than half the women admitted to hospital obstetric wards are suffering complications from unsafe abortions. He believes the global gag rule "inappropriately seeks to influence Nepal's democratic process," so his organization made the tough decision not to take U.S. funds. It's one of the few that did so. He understands why others have gone along with the gag rule, "not wanting to disrupt their work providing services to thousands of low income women."

Tamang believes the rule--which is backed by a signed contract and field spot checks--will have a "chilling effect" by discouraging nongovernmental organizations (NGOs) from assisting in public education, as well as advocating to legalize abortion. And he worries that other organizations will shy away from his own.

On May 16, the Congress voted to uphold Bush's gag policy, which passed on a 218-to-210 vote attached to a State Department reauthorization bill. But the slim margin of that vote, and a willingness on the part of some Senate Republicans to challenge the policy, has given pro-choice groups a glimmer of hope.

A 1972 federal law has banned foreign organizations from using U.S. taxpayer money to pay for abortions. But the gag rule goes much further.

"While the gag rule is not stopping one single abortion, it is leading to an increase in the number of deaths related to unsafe abortions by denying women access to information, access to adequate care as well as counseling," said Senator Barbara Boxer, Democrat of California. She and Harry Reid, Democrat of Nevada, along with five Republican co-sponsors, led an attempt to repeal the rule using the Congressional Review Act in March. Bush sidestepped this by issuing the language of his rule as an executive memorandum--immune to procedural review.

Now, the Center for Reproductive Law and Policy, joined by Human Rights Watch and the Lawyers Committee for Human Rights, has filed a lawsuit against Bush on the grounds that the policy violates free speech rights of Americans because it discriminates against a particular viewpoint. (Abortion foes are not gagged; they can freely express their views on abortion policies, even if they accept federal funds.) One aim of the lawsuit is to make clear that the policy doesn't affect merely abortion funding, but advocacy efforts as well.

"Human rights leaders recognize that without free speech, it is impossible for U.S.-based groups to open the world's eyes to the horror of human rights abuses, whether political torture, land mines, or unsafe abortion, which claims the lives of 213 women every day worldwide," said Janet Benshoof, the center's president, on June 6, the day it filed its lawsuit.

Other pro-choice groups, such as the International Planned Parenthood Federation, are just as critical. The federation lost $17 million in USAID family planning funds and commodities--25 percent of its funding--back in 1984. But leader Ingar Brueggemann says it will "stick to its mandate to support the poor and marginalized [and] therefore not accept nor certify the Mexico City Policy." The gag rule, she said, "hurts the poorest in the world."

Twenty-six percent of the world's people live in seventy-four countries where abortion is prohibited altogether or allowed only to save a woman's life. More than 78,000 women die from unsafe, illegal abortions every year, according to Senator Boxer.

In Bolivia, abortion is allowed only if the pregnancy is the result of rape or incest or if the woman's life is at stake. With the highest maternal mortality rate in Latin American, according to the Center for Reproductive Law and Policy, Bolivia sees one woman die every day from an unsafe abortion. A group of fifteen nongovernmental organizations got together to lobby the government to intervene in this public health crisis. But because of the global gag rule, four organizations had to drop out, according to Jaime Miguel Telleria, executive director of CISTAC (Centro de Investigacion Social Technologia Apropiada y Capacitacion), a group that educates Bolivians on reproductive health. Telleria's group has refused to comply with the gag rule, and so his organization lost a quarter of its $200,000 budget.

Complying with the gag rule "would make us accomplices in the continuation of this grave public health and rights issue," says Telleria.

In Senegal, women in the countryside frequently inject pomegranate juice into their vaginas and uteruses to induce abortion, but the juice badly burns them, sometimes causing death, says Codou Bop, executive director of Groupe de Recherche Femmes et Lois au Senegal. Abortion in Senegal is permitted only to save a woman's life.

Nepal's uniqueness may lie only in the harshness of the sentences it metes out. Fortunately, this may soon change.

Upreti is hopeful that abortion will be legalized in Nepal, perhaps yet this year. But, she says, that's just a first step. Next comes making the procedure safe and accessible, especially for women in the rural areas. Many health services in these areas are provided by nongovernmental organizations, and "a significant portion of this community" is funded by USAID, she says.

As she sees it, overcoming the hurdle of access to a full range of health services is more daunting than the political quest for legalization. That makes it all the more important to have freedom of speech and advocacy. Yet Upreti notes that the NGO Coordination Council, a consortium of groups that work on reproductive health issues in Nepal, is sponsored by USAID. Another key group sponsored by USAID is the Safe Motherhood Network.

"We might somehow manage to push through a more comprehensive law that is in tune with human rights standards," says Upreti. "But what happens after that if abortion does become legal but the main NGOs that are providing health services cannot provide it? The biggest threat now is from U.S. foreign policy."

Melanie Conklin is a freelance writer in Madison, Wisconsin. For more information on the gag rule, visit www.crlp.org.